Annals for Educators - May 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesMay 2022Annals for Educators - May 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202205170 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsPrescribing Nirmatrelvir–Ritonavir: How to Recognize and Manage Drug–Drug InteractionsNirmatrelvir–ritonavir (NMV/r) is now being used to treat high-risk patients with mild to moderate COVID-19. This article provides advice to clinicians regarding recognition of medications likely to interact with NMV/r and suggests approaches to managing such drug–drug interactions.Use this article to:Review the currently approved indications for NMV/r with your learners.Invite a pharmacist to your session to explain the process your learners would need to follow to obtain NMV/r for patients cared for in your health system and geographic locale.Review the interactions of commonly prescribed medications with NMV/r, and discuss which medications can be safely discontinued during the course of NMV/r.Have your learners retrieve the medication list for one of their patients and then use the Liverpool COVID-19 drug interaction checker to determine whether that patient could safely receive NMV/r and whether any modification of their routine medication regimens would be necessary. Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World DataThis retrospective cohort study analyzed data from a large integrated health care organization to determine the rates of shoulder conditions after intramuscular vaccinations in the deltoid muscle and compared characteristics of vaccinated persons with and without shoulder conditions.Use this article to:Demonstrate the appropriate technique for administration of an intramuscular vaccine.Review the characteristics associated with shoulder conditions after administration of a vaccine into the deltoid muscle.Discuss appropriate evaluation and management of a patient who presents with a shoulder injury after vaccination.Using the data reported in this study, role-play counseling a patient who is hesitant to get vaccinated because they are worried about a shoulder injury.Annals Consult Guys - Physical Examination During Telemedicine VisitsThis video discusses strategies for conducting some aspects of physical examination during telemedicine visits.Use this multimedia article to:Ask your learners about their experience with telemedicine. How many patients did they see via telemedicine? What did they like or dislike about it?Ask your learners to give examples of clinical scenarios that would and would not be appropriate for a telemedicine visit.Watch the video with your learners.Have your learners role-play how they would guide a patient through some of the physical examination techniques discussed in the video.Comparison of SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge. A Cross-Sectional StudyThis study compared the performance of the BinaxNOW rapid antigen test versus reverse transcriptase polymerase chain reaction (PCR) for community-based detection of infection with the Omicron variant of SARS-CoV-2 in San Francisco, California, during January 2022.Use this article to:Review the clinical scenarios in which a rapid antigen test for SARS-CoV-2 is likely to be more useful than a PCR test.Demonstrate how to correctly perform a BinaxNOW rapid antigen test.Ask your learners whether they think these results are likely generalizable to other rapid tests and other SARS-CoV-2 variants.Health Care DisparitiesAssociation Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults. A Cohort StudyHealth Equity and Critical Care Survivorship: Where Do We Go From Here?This study analyzed data from the National Health and Aging Trends Study to evaluate the association between dual eligibility status for Medicare and Medicaid and decline in function, cognition, and mental health after an intensive care unit hospitalization and concluded that socioeconomic disadvantage is associated with worse outcomes after critical illness. The accompanying editorial calls for study of the biological mechanisms underlying post–intensive care deficits, the effectiveness of various approaches to care delivery after critical illness, and supports for survivors that are effective and equitable.Use this article and the editorial to:Ask your learners if they have observed socioeconomic disparities in how patients fare after critical illness.Discuss potential reasons for these disparities.Brainstorm about interventions before, during, and after critical illness episodes that have the potential to reduce the observed disparities.Clinical GuidelinesThe Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice GuidelineShifting Focus to Evidence-Based Management of Substance Use DisordersThe article summarizes key recommendations from a joint clinical practice guideline from the U.S. Department of Veterans Affairs and the U.S. Department of Defense on the management of alcohol use disorder, opioid use disorder, and other substance use disorders among veterans. The accompanying editorial discusses the guideline and believes that the recommendations also apply to the general population.Use this article and the editorial to:Review the guideline recommendations with your learners.Discuss aspects of the recommendations that are and are not easily transferable to a nonveteran population.Invite an addiction medicine expert to review the processes for providing care to persons with various substance use disorders within your health system.Care of the Patient After Metabolic and Bariatric SurgeryWeight loss surgery, also known as metabolic and bariatric surgery, is an effective weight loss treatment that is associated with anatomic and physiologic changes that may include decreased absorption of micronutrients and alterations in gut–brain hormonal regulation that affect many aspects of health. Although the overall rate of serious complications is less than 5%, patients require ongoing monitoring of their physical and mental health for lasting success. Primary care clinicians are in an ideal situation to monitor for nonserious complications in the short and long term, adjust management of chronic diseases accordingly, and monitor for mental health changes.Use this article to:Review the clinical indications for bariatric surgery.Invite a bariatric medicine or surgery specialist to your teaching session to review the various bariatric procedures and the advantages and disadvantages of each.Review key issues that primary care physicians should be aware of for supporting patients' health in the short and long term after metabolic and bariatric surgery.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics May 2022Volume 175, Issue 5Page: ED5 ePublished: 17 May 2022 Issue Published: May 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...